In a windowless office in the basement of the West Wing, behind a utility room and next to a fire-alarm panel, David Simas is marking up another whiteboard with blue ink, hoping to explain one more time just how the President’s health care reform law will work when the time comes for uninusured Americans to sign up this fall.

The abstraction of Obamacare is about to become reality. But will anyone know what to do? An estimated 7 million Americans will join the first health exchanges from Oct. 1, 2013, to April 1, 2014, and most have no idea how to do that. And for the millions who are already covered by some early Obamacare benefits, Simas adds, “We need to continue to remind them of what they’re getting.”

If Simas, 42, has the nervous energy of the 2012 campaign, where he served as opinion-research director, there is a good reason. Though Barack Obama has competed in his last election, he has one more campaign ahead of him. This fall, Obamacare will go into full effect, with the promise of insuring as many as 40 million Americans if it succeeds. But it could still fail.

To prevent that, Obama-land is going on offense. Organizing for Action, the grassroots group spun out of the President’s campaign, has made selling the already-passed bill a top priority with its first television ad. Enroll America, a nonprofit coalition of community groups and insurers that has been promoted by the White House and is staffed by Obama campaign alumni, launched its “Get Covered America” campaign to educate uninsured Americans about the exchanges.

At the White House, health care implementation has become an obsession. Chief of Staff Denis McDonough spends two hours a day on Obamacare implementation, staffers said, and senior aides like Simas and Tara McGuinness, who joined the White House in April as a senior communications adviser, work on the issue nearly full-time. Hardly a week goes by without Obama finding some way to plug the effort as well.

The reason: the law is increasingly unpopular. According to a NBC News–Wall Street Journal poll released earlier this month, 49% of Americans now believe the law is a bad idea, the highest percentage recorded, with only 37% saying it is a good thing. Many states have already opted out of key provisions to expand Medicaid. In Washington, Republicans continue to lay siege to the law; they have voted to repeal it 37 times in the U.S. House.

That unpopularity threatens one of the law’s most ambitious goals—establishing health care exchanges allowing uninsured Americans to purchase affordable coverage. The exchanges need roughly 2.7 million healthy 18-t0-35-year-olds to sign up to be solvent. The majority of that group is nonwhite and male, according to Simas’ data, and a third are located in just three states: California, Texas and Florida. If too few choose to enroll because they don’t know about the law, don’t like it, or feel they don’t need insurance, the exchanges will fail. And so will the law.

The Administration has plotted an extensive social-media campaign designed to reach the young and healthy and is soliciting sports teams to help raise awareness. More than 10 staffers in the Office of Public Engagement are marshalling the help of Latino and African American groups and community nonprofits. And Simas has spent countless hours surrounded by maps of media markets and demographic data on the uninsured trying to remind prospective enrollees of the benefits available to them: “It’s that guy in Dallas, it’s the woman in Los Angeles, it’s the family in Miami-Dade,” he says.

Obama aides have been saying such things for years, with little effect. But now the clock is ticking, and Obama is running out of time to make his signature achievement stick.

I have a 5 month full time job, and they don't offer coverage until 90 days in; and it's a high deductible plan. I also have a part time job that lets me buy a no employer subsidy tiny policy that maxes out at $1500. My policy is so bad that I went for 5 months without using it, only then using it for an emergency.

Obamacare MIGHT let me buy some sort of semi decent policy next year. But what we should have done is Medicare for all ages, (assuming Medicare waste fixes), where premiums are based on income, and where employers can choose to supplement with add ons (like a better room in a hospital). Single payor coverage, one nationwide risk pool, a lot less money paying for executives salaries or for dividends and the like. Health coverage should not depend on employment.

Of course, as suggested above, Medicare has some problems. One huge one; Medicare underpays doctors in many cases, and overpays hospitals as well. One treatment I'm aware of has Medicare pay a doctor $3800 (though it costs the doctor hundreds more), while Medicare pays a nearby hospital $38,000 for the same exact treatment. That is truly sick!

TexasTruBlu - I have little doubt that the point was to to increase the amount of money that is directly or indirectly controlled by our friends inside the beltway. It seems to always be the point, regardless of which party is nominally in power at any given moment. Republicans want more money that they can direct to their friends, and democrats want more money that they can direct to their friends. Both sides agree that the money has to get to DC first before they can do anything with it, so both sides pass laws that funnel more cash in their direction. It's what they call that "bipartisanship".

In two consecutive elections, you’ve carried Barack Obama to victory. When he said, “We are the ones we’ve been waiting for,” he basically meant you. You voted for Obama by a margin of 66 percent to 32 percent in 2008, and, despite a horrendous economy for people your age, by nearly that much again in 2012."

How can the government people who came up with the PPACA not have foreseen the incongruity of this? They are supposed to be smart people with access to lots of information and, I would think, have a lot of insight into human behavior (being politicians and all). But really, you don't need all that to realize that a young person making say $30,000 is NOT going to shell out $2000-$5000 a year for health insurance that he doesn't want or need. He will pay the deadbeat tax of $300 instead.that

Do they really think that young people are stupid? Do they think that some ad featuring sports figures who make $millions$ a year are goring to persuade a young employee to spend $2500 a year ($4000 if they smoke) out of their $30,000 salary on something they don't use? People of any age will not part with a dime more than they have to. It's a simple truth that they won't.

If they would, then the government would have been running ads for years telling people to pay $2500 more than they owe every year on their tax return.

None of this has anything to do with Healthcare or the American people ... it is politics and politics is $$$. The right will do ANYTHING to regain power ... as a matter of fact they have introduced a slew of new political tactics sure to be used by the LEFT when the balance of power shifts back to the right.

There is a way back though ... it involves reforming our politicians ... return them to their intended roles as public servants not the privateer$ then have become.

No country can sustain single payer with out rationing services. This means allowing people who could live to die. The UK calls the Quality of life points. Get to few like being 70 years old and get sick and you are done for. Now you may want the government controlling such situations but many do not.

@bayernfan1960 It was designed to fail. The failure will be blamed on Capitalism and the Repubs. It is the lead in to a single payer system like in the United Kingdom. Take a look I think it should scare you to death

@manapp99@mantisdragon91@John@time The Occupy movement didn't have the corporate PR folks and money men the Tea Party folks did. However it is a good example of what the Tea Party would have looked like without the Koch Brothers and Tobacco's planning and financing.

Department of Medicine, University of California San Francisco, Center for Tobacco Control Research and Education, San Francisco, California, USA

Correspondence to
Stanton A Glantz, Department of
Medicine, University of California San Francisco, Center for Tobacco
Control Research and
Education, Room 366 Library, 530
Parnassus, San Francisco, CA 94143-1390, USA; glantz@medicine.ucsf.edu

Received 1 October 2012

Accepted 29 January 2013

Published Online First 8 February 2013

Abstract

Background
The Tea Party, which gained prominence in the USA in 2009, advocates
limited government and low taxes. Tea Party organisations,
particularly Americans for
Prosperity and FreedomWorks, oppose smoke-free laws and tobacco taxes.

Methods We used the Legacy Tobacco Documents Library, the Wayback Machine, Google, LexisNexis, the Center for Media and Democracy
and the Center for Responsive Politics (opensecrets.org) to examine the tobacco companies’ connections to the Tea Party.

Results
Starting in the 1980s, tobacco companies worked to create the appearance
of broad opposition to tobacco control policies
by attempting to create a grassroots
smokers’ rights movement. Simultaneously, they funded and worked
through third-party
groups, such as Citizens for a Sound
Economy, the predecessor of AFP and FreedomWorks, to accomplish their
economic and political
agenda. There has been continuity of
some key players, strategies and messages from these groups to Tea
Party organisations.
As of 2012, the Tea Party was
beginning to spread internationally.

Conclusions
Rather than being a purely grassroots movement that spontaneously
developed in 2009, the Tea Party has developed over time,
in part through decades of work by
the tobacco industry and other corporate interests. It is important for
tobacco control
advocates in the USA and
internationally, to anticipate and counter Tea Party opposition to
tobacco control policies and ensure
that policymakers, the media and the
public understand the longstanding connection between the tobacco
industry, the Tea Party
and its associated organisations.

@Gaius_Grachus@mantisdragon91@ManuelNoriega And yet again who provide their initial funding and the logos. Who makes sure they stay relevant in the news and gives them more coverage than they deserve. You may not see the Koch and Tobacco money the world does.

@mantisdragon91@Gaius_Grachus@ManuelNoriega There money comes from a lot of people like me. Just joes as far as the logos do you have any idea how many TEA party groups there are? And they all have different logos or steal one another's or steal them off the internet. These are the people of the USA not some Obama BOT or Union mob of thugs told what to do. Jeesh! you fellows need to get out and meet some of these enemies of the state you fear more than the people who have sworn to kill you

@Gaius_Grachus@mantisdragon91@ManuelNoriega Really so why were their logos trademarked over a decade ago? Where did their money come from. Who pays for those shiny buses that shuttle them around and holds national conventions for their activists?

@mantisdragon91@Gaius_Grachus@ManuelNoriega No the TEA party are about as Grass roots as you can get. Fun to watch them have a meeting and try to plan anything although they have gotten a lot better. Talk about some one who is brain washed you mister have a serious problem with reality.

@mantisdragon91@Gaius_Grachus@ManuelNoriega Ah yes let us team up all the Progressive Totalitarians to try and destroy those dangerous constitutional conservatives. Well you may be correct Hayek suggests that people generally enslave themselves and you are well on the way